White Smoke

[I have been busy as hell and without/away from a computer for most of this week, so that explains the light posting schedule/lack of response to e-mails.]

When a new Pope is selected, the news is announced to the world via white smoke emanating from the chimney above St. Peter's square.  What follows is a period of great suspense before one of the Cardinals appears on the balcony to announce to the world, "Habemus Papam!": We have a Pope. 

To anybody with a vested interest in the Pope, the period of time between seeing the white smoke and the appearance of the new Pope himself must be excruciating.  For a cancer patient, the period of time between learning that your previously-opposed doctors are now "on the same page now on how to move forward" and finding out what "page" they are actually on is possibly even more excruciating.  And that's where I'm at now. 

By way of background, I had two goals this week:  Follow up with Dr. Zelenetz from Sloan-Kettering, and get Dr. Li (U-M) and Dr. Anderson (Henry Ford) in touch with Dr. Advani from Stanford.  Dr. Zelenetz is out this week; I might be able to speak with him on Monday.  However, I have made progress with Dr. Advani.  I spent five days trying to get Dr. Li and Dr. Anderson to call her, and trust me, trying to get three doctors in touch with each other is no small task. 

But it seems to have happened, and Dr. Advani's assistant responded to an e-mail yesterday thusly:

Hi Nick,

Dr. Advani spent about 20 minutes discussing your case and both oncologist are on the same page now on how to move forward and will be in the best position to discuss plan with you.

So...yeah.  I'm ok with not being able to speak to the doctor directly - Stanford was always up front about the fact that Dr. Advani would review my case and speak to my doctors, and then have them follow up with me.  I understand that hospitals want to limit patient-doctor contact in these informal reviews. 

But I have no clue how a 20-minute conversation could bring "both oncologists" who have disagreed for months onto "the same page."  So much so that I followed up by asking the question again, and again getting an affirmative answer.  So, there you are.

For what it's worth, I'm not entirely concerned with what page my doctors are on, so long as they are on the same one.  What keeps me up at night is not the prospect of doing  more treatment, it's the uncertainty surrounding that decision.  So whether Dr. Anderson now thinks more treatment is a better option or Dr. Li is cool with my original regimen is not of great importance (of course, I would prefer one to the other).  Getting them to agree would go a long way toward alleviating much of my stress. 

So today is "try to get in touch with my doctors knowing that it could possibly lead to a 6pm friday phone call" day.  I'll keep you posted. 

The problem with Detroit: The streets...don't have enough plants

[Part 6 in the "Libertarian cancer patient reads the Sunday paper" series. Intro here. Part 1 here. Part 2 here. Part 3 here. Part 4 here. Part 5 here.] 


I KNOW WHAT'S WRONG WITH DETROIT: THE STREETS...DON'T HAVE ENOUGH PLANTS ON THEM.  Page 7A gives us an interesting piece by John Gallagher, the Freep's architecture/urban planning writer.  Entitled, "New Michigan law gives walkers, bikers a share of streets," Gallagher examines a little-noticed act passed by the Michigan Legislature:

The act directs transportation planners in the state to plan for what's called complete streets -- streets that accommodate pedestrians and bicyclists along with cars and trucks.

It means that Michigan is now on the record acknowledging that it is a mistake to build roadways just to move high volumes of vehicle traffic as fast as possible. Designing healthy cities means considering all potential users of a street, regardless of their age or ability.

First, I really enjoy that the act "directs transportation planners to plan."  So much of legislating is about doing a lot (and spending a ton) without ever really doing anything.  So when a guy strongly in favor of a law reveals (to his credit, and honestly) that the law only "directs transportation planners to plan," that's a red flag.  There will be commissions.  There will be reports.  There will be money spent.  But I doubt any of this will actually lead to a real impact on anything.

Second, correct me if I'm wrong, but don't most streets already "accommodate pedestrians and bicyclists."  Perhaps not with dedicated lanes, but I'm not aware of too many urban streets that are completely inaccessible to pedestrians and bicyclists.  The accompanying picture clarified this issue:

Apparently we're supposed to throw some plants in the street

Finally, I enjoyed the sentence, "Michigan is now on the record acknowledging that it is a mistake to build roadways just to move high volumes of vehicle traffic as fast as possible."  Because 1) Isn't that the point a street?  At least that's my belief and 2) This is really a reflection of John Gallagher's belief that "it is a mistake to build roadways just to move high volumes of traffic."  The only difference is that I don't want or need my beliefs enshrined in law.  I don't care to direct planners to plan for things that I believe should be done.

But alas, this might not even be an issue, because true to form:

The act doesn't mean we'll see bicycle lanes on all Detroit streets anytime soon. The Legislature did not allocate any new money, and the act allows transportation planners to ignore it if sufficient need arises -- say, the safety of the public or overall cost.

At least one person is happy with this change, though:

It's a dramatic change, says Scott Clein, an engineer with the Detroit office of the engineering firm Giffels-Webster, who does a lot of work designing nonmotorized transportation links.

Even so, Clein says, "It's a great start. The state has passed a bill that says flat out (that complete streets) has to be considered equally as important as how much traffic you can get from point A to point B. That's important."

Hey look! It's a private company that's will benefit at the expense of others (say, an engineering firm that does no work designing nonmotorized transportation links) because of some random legislative decree!

So what does this bill really do?  Well to figure that out, you have to...look at the bill.  And since I am a great journalist - or, rather, a guy whose back is killing him because they shot laser beams at it for three weeks - I've done that for you.  Fun excerpts below.  Please, hide the children:

The state transportation department or a county, city, or village receiving money from the Michigan transportation fund annually shall prepare a 5-year program for the improvement of qualified nonmotorized facilities which when implemented would result in the expenditure of an amount equal to at least 1%

You would think any rudimentary understanding of world history would prevent legislators from enacting Five-Year Plans, but who am I to judge?

(2) The state transportation commission shall do both of the following by not later than 2 years after the effective date of the amendatory act that added this section:

(a) Adopt a complete streets policy for the department.

(b) Develop a model complete streets policy or policies to be made available for use by municipalities and counties.

BUT WHO WILL DEVELOP THE POLICY TO GOVERN THE DEVELOPMENT OF THE POLICIES?!!?  And I wonder how many points "amendatory" would get me in scrabble?

Before a municipality approves any project...it shall consult with the affected agency.  Before the department submits its multiyear capital plan to the commission or a county road agency approves its multiyear capital plan...the department or county road agency shall consult with the municipality.

"Said consultation must take place at a gentleman's entertainment club on, near, or perpendicular to Michigan Avenue in the City of Detroit in the County of Wayne in the State of Michigan."

(6) A complete streets advisory council is created within the department. The advisory council shall consist of the following members appointed by the governor:

I'm sparing you the rest of the list.  Here's the cliff's notes version:  There will be seventeen (17!) members appointed to this council, including a representative from the AARP, the league of Michigan bicyclists, a "pedestrian organization" (which, I presume, means "somebody who walks), and representatives from the state department of community health, natural resources and the environment, and the state housing development authority. 

I'm done with that now.  You can read the rest of it if you're a real masochist or currently unemployed cancer patient. I don't see the need.  As I wrote about the Maryland Professionalism Course:

People with big ideas will come into power.  Commissions will be formed.  Those commissions will "study" issues and issue reports.  Those reports will have recommendations.  Those recommendations will invariably lead to more requirements and rules.  And the process will repeat.

It's bureaucracy baby! Feel the excitement!

Near the end of the piece, Gallagher describes real-life examples of "complete streets," and, again to his credit, acknowledges some people aren't quite happy with the policy:

Not long ago, visiting New York City, I saw some excellent examples of complete streets. A traffic lane had been converted to combined bicycle/pedestrian use, with a clear separation from the vehicle traffic.

Not everyone is happy with the new way there; merchants complain that parking spaces are being lost to bike lanes. But there's no doubt many residents are happy with the new arrangement.

So basically, some people like the complete streets, other people don't. Fair enough. That's the way most things in the world work.

So how about this: do nothing.  Why a new law, with new commissions, and new policies, and a bunch of make-work policies for a bunch of bureaucrats that won't lead to any real changes to anything for several years, if ever, but will probably cost money in the process?  Why not let population-dense cities with high volumes of foot traffic study the feasibility of complete streets, while sparsely-populated cities with few pedestrians and bicyclists don't have to waste their times with committees, reports, policies, and consultations? 

For what it's worth, I rather like the "complete streets" idea...when I'm walking.  And when I'm driving, I'd probably prefer a design that gets me from point A to point B the fastest.  I'm not sure what supporters mean when they say this is a good "first step," (compulsory "complete streets?" Giant plants in the road mandated by the state legislature?) But I wouldn't celebrate ramming either of those ideas down the throats of my fellow citizens (and using their own money to do so).

What just happened?

Late on Thursday I decided I was done.  Done with what, I don't know.  But I decided I needed to get out.  So I rented a car on Thursday night, and set out Friday morning for the District of Columbia. 

I took 94 down to the Lodge in Detroit, and got on the Lodge heading South.  It was early in the morning, so the sun wasn't up yet.  As I took the ramp from 94 to the Lodge, the lit-up facade of Henry Ford Hospital was clearly visible in my rear view mirror.  Poignant, I know.

***

I'm sitting here in my apartment in DC and I have to be at work in about 10 hours.  And my only thought is, "What the hell just happened?"  Really.  I feel like I blacked out sometime in early June and I just came to. 

In part, my decision to up and leave for DC was pragmatic:  I have orientation this week, and I at least wanted to get this out of the way.  Plus, I haven't been able to speak directly with the doctors at either Sloan-Kettering or Stanford, and I'm really hoping to do that before I close the book on that issue. 

But being in DC certainly makes everything feel different.  Cancer is not my number 1 concern around here.  It's still always with me, of course.  But when I'm here, cancer takes a back seat to normal life activities. 

I don't know what to think about things, really.  I've mentioned before how I'll never get over the timing of all this, and I still think that's true.  This thing hit me hours after I got back to Michigan in July, and here, hours before I'm supposed to begin a new job, I'm still debating whether or not I'll do more treatment. 

I suppose starting a new job is one of those "major life events," and honestly, it's just another day to me.  I don't know if that's good or bad.  I think it's a good thing.  I'm not nervous.  I'm not anxious.  I'm not worried.  I guess there's some moderate excitement, but not too much, since it's entirely within the realm of possiblity that I'll be flying back to Detroit in a week. 

Mostly, what I feel is this:  I have been going a million miles a minute every day since June, and it makes starting a new job feel like just another day.  There are only a few things in life that are somewhere in your mind virtually every minute of every day.  The bar exam and cancer are two of those things.  The bar exam stuff only lasted a couple months.  I'm not sure how long the other one will last. 

***

It's pretty tough for me to look forward these days, since I spent months trying to avoid doing just that.  I just tried to take everything one day at a time.  Tried to never get too high or too low.  Tried to avoid looking ahead because I didn't know how things were going to play out, and I didn't want to get burned by things. 

Now, I feel like I'm supposed to transition from "cancer patient" to "working guy," or whatever phrase you want to use, and they're pretty different roles.  I try to look ahead to a new job, a new assignment, and really, a new life.  But I can't stop looking back and saying, "I can't believe that just happened."  Because...I can't believe what just happened.  In July, my life plan was to take the bar, do some stuff, then start work in January.  And I guess I did exactly that.  But holy hell, that "stuff" was not what I expected. 

I guess the issue is this:  Starting a new job - starting a career, in my case - is a pretty big deal.  If, like me, you were offered a job over a year before you actually start it, you spend some time thinking about that job.  And I did just that...right up until the end of July.  And I haven't really thought about it since.  I mean, I always thought about my start date.  But it wasn't so much "me starting work" as it was "me being done with cancer." 

And that's what I've been dealing with for over five months, every single minute of every single day.  That's been my sole focus.  I haven't really had time to think of much else.  I'm still getting used to living in remission, in a new place, in a new city, with a gun pointed at me, and it's hard to pile "new job" on top of all that.  I've been focusing on this day for about 15 months now, and it's like it completely snuck up on me. 

***

But here's why I know I'll be just fine:  Because nothing - not a new job, not a difficult assignment, not a deposition, a court appearance, a brief, a new job, a new city, a new apartment - nothing has the potential to kill me.  And I faced something that definitely could.  And I beat it.  So after that...what is there to fear?  As much as cancer grinds you down and beats you up, it is the ultimate "that which does not kill me only makes me stronger" event. 

Cancer didn't kill me.  In failing to do so, it made me stronger.  It made me different, in a million little ways I'll try to detail here over the next few weeks.  And while I once looked at tomorrow and took my lack of emotion as a troubling sign, I'm now rather pleased about it.  Because once you've been to hell, there's very little that this world can dish out that you can't handle. 

I'll get up tomorrow, possibly shave, possibly throw on a suit, and go to work just like everybody else.  And immediately screw with the first person who asks me, "So what have you been doing for the past five months?"